Download PDF
Nuklearmedizin 2019; 58(05): 371-378
DOI: 10.1055/a-1000-6951
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

Vergleich von Fluor(18)-Fluordesoxyglucose und Gallium(68)-citrat PET/CT bei Patienten mit Tuberkulose
Alfred O. Ankrah
1   Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
2   Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
3   Nuclear Medicine Unit, Korle Bu Teaching Hospital, National Centre for Radiotherapy and Nuclear Medicine, Accra, Ghana
,
Ismaheel O. Lawal
1   Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
,
Tebatso M.G. Boshomane
1   Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
,
Hans C. Klein
2   Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
,
Thomas Ebenhan
1   Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
,
Rudi A.J.O. Dierckx
2   Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
,
Mariza Vorster
1   Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
,
Andor W.J.M. Glaudemans
2   Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
,
Mike M. Sathekge
1   Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
› Author Affiliations
Further Information

Publication History

05 July 2019

21 August 2019

Publication Date:
04 September 2019 (online)

    Permissions and Reprints

Abstract

18F-FDG and 68Ga-citrate PET/CT have both been shown to be useful in the management of tuberculosis (TB). We compared the abnormal PET findings of 18F-FDG- and 68Ga-citrate-PET/CT in patients with TB.

Methods Patients with TB on anti-TB therapy were included. Patients had a set of PET scans consisting of both 18F-FDG and 68Ga-citrate. Abnormal lesions were identified, and the two sets of scans were compared. The scan findings were correlated to the clinical data as provided by the attending physician.

Results 46 PET/CT scans were performed in 18 patients, 11 (61 %) were female, and the mean age was 35.7 ± 13.5 years. Five patients also had both studies for follow-up reasons during the use of anti-TB therapy. Thirteen patients were co-infected with HIV. 18F-FDG detected more lesions than 68Ga-citrate (261 vs. 166, p < 0.0001). 68Ga-citrate showed a better definition of intracerebral lesions due to the absence of tracer uptake in the brain. The mean SUVmax was higher for 18F-FDG compared to 68Ga-citrate (5.73 vs. 3.01, p < 0.0001). We found a significant correlation between the SUVmax of lesions that were determined by both tracers (r = 0.4968, p < 0.0001).

Conclusion Preliminary data shows 18F-FDG-PET detects more abnormal lesions in TB compared to 68Ga-citrate. However, 68Ga-citrate has better lesion definition in the brain and is therefore especially useful when intracranial TB is suspected.

Zusammenfassung

18F-FDG und 68Ga-Citrat PET/CT haben sich beide als nützlich bei der Behandlung von Tuberkulose (TB) erwiesen. Wir verglichen die abnormalen PET-Befunde von 18F-FDG- und 68Ga-Citrat PET/CT bei Patienten mit TB.

Methoden Patienten mit TB unter antituberkulotischer Behandlung wurden eingeschlossen. Die Patienten hatten einen Datensatz von PET- Aufnahmen, die sowohl mit 18F-FDG als auch mit 68Ga-Citrat durchgeführt wurden. Anormale Läsionen wurden identifiziert und die beiden Datensätze der Aufnahmen wurden verglichen. Die Bildgebungsbefunde wurden mit den klinischen Daten des behandelnden Arztes korreliert.

Ergebnisse 46 PET/CT-Untersuchungen wurden bei 18 Patienten durchgeführt, 11 (61 %) waren weiblich und das Durchschnittsalter betrug 35,7 ± 13,5 Jahre. Fünf Patienten hatten beide Untersuchungen auch als Verlaufskontrolle während der antituberkulotischer Behandlung. Dreizehn Patienten hatten eine HIV-Koinfektion. 18F-FDG entdeckte mehr Läsionen als 68Ga-Citrat (261 vs. 166, p < 0,0001). 68Ga-Citrat zeigte eine bessere Definition von intrazerebralen Läsionen, da keine Tracer vom Gehirn aufgenommen wurden. Der mittlere SUVmax war für 18F-FDG höher als für 68Ga-Citrat (5,73 vs. 3,01, p < 0,0001). Wir fanden eine signifikante Korrelation zwischen den SUVmax Werten von Läsionen, die mit beiden Tracern bestimmt wurden (r = 0,4968, p < 0,0001).

Schlussfolgerung Vorläufige Daten zeigen, dass die PET mit 18F-FDG im Vergleich zu 68Ga-Citrat mehr abnormale Läsionen bei TB erkennt. 68Ga-Citrat zeigt jedoch eine bessere Definition der Läsionen im Gehirn und ist daher besonders nützlich, wenn der Verdacht auf intrakranielle TB besteht.

Key words

Tuberculosis - 18F-FDG - 68Ga-citrate - PET/CT

Schlüsselwörter

68Ga-Citrat - PET/CT - 18F-FDG
 

  • References

  • 1 Global tuberculosis report 2018. Geneva: World Health Organization; 2018. Im Internet: http://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf Assessed January 18, 2019
  • 2 Improving the diagnosis and treatment for smear-negative pulmonary and extrapulmonary tuberculosis among adults and adolescents. Recommendations for HIV-prevalent and resource-constrained settings. WHO; 2007 Im Internet: http://apps.who.int/iris/bitstream/handle/10665/69463/WHO_HTM_TB_2007.379_eng.pdf;jsessionid=244682331B1F968F813FD965BF270051?sequence=1 Assessed January 18, 2019
    PubMedGoogle Scholar
  • 3 Wilson D, Mbhele L, Badri M. et al. Evaluation of the World Health Organization algorithm for the diagnosis of HIV-associated sputum smear-negative tuberculosis. Int J Tuberc Lung Dis 2011; 15: 919-924
    CrossrefPubMedGoogle Scholar
  • 4 Department of Health, Republic of South Africa. National Tuberculosis Management Guidelines, Department of Health, South Africa 2014. Im Internet: http://www.tbonline.info/media/uploads/documents/ntcp_adult_tb-guidelines-27.5.2014.pdf Assessed 18 January 2019
    Google Scholar
  • 5 Walley J, Kunutsor S, Evans M. et al. Validation in Uganda of the new WHO diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV prevalent settings. J Acquir Immune Defic Syndr 2011; 57: e93-e100
    CrossrefPubMedGoogle Scholar
  • 6 Linguissi LS, Vouvoungui CJ, Poulain P. et al. Diagnosis of smear-negative pulmonary tuberculosis based on clinical signs in the Republic of Congo. BMC Res Notes 2015; 8: 804
    CrossrefPubMedGoogle Scholar
  • 7 The Stop TB Strategy.WHO. Im Internet: www.who.int/tb/strategy/stop_tb_strategy/en/ Accessed August 4, 2018
  • 8 Sathekge M, Maes A, Van de Wiele C. FDG-PET imaging in HIV infection and tuberculosis. Semin Nucl Med 2013; 43: 349-366
    CrossrefPubMedGoogle Scholar
  • 9 Ankrah AO, van der Werf TS, de Vries EF. et al. PET/CT imaging of Mycobacterium tuberculosis infection. Clin Transl Imaging 2016; 4: 131-144
    CrossrefPubMedGoogle Scholar
  • 10 Banerjee SR, Pomper MG. Clinical Applications of Gallium-68. Appl Radiat Isot 2013; 0: 2-13
    Google Scholar
  • 11 Vorster M, Maes A, Wiele Cv. et al. Gallium-68 PET: A Powerful Generator-based Alternative to Infection and Inflammation Imaging. Semin Nucl Med 2016; 46: 436-447
    CrossrefPubMedGoogle Scholar
  • 12 Nanni C, Errani C, Boriani L. et al. 68Ga-citrate PET/CT for evaluating patients with infections of the bone: preliminary results. J Nucl Med 2010; 51: 1932-1936
    CrossrefPubMedGoogle Scholar
  • 13 Kumar V, Boddeti DK, Evans SG. et al. (68)Ga-Citrate-PET for diagnostic imaging of infection in rats and for intra-abdominal infection in a patient. Curr Radiopharm 2012; 5: 71-75
    CrossrefPubMedGoogle Scholar
  • 14 Vorster M, Maes A, Van de Wiele C. et al. 68Ga-citrate PET/CT in Tuberculosis: A pilot study. Q J Nucl Med Mol Imaging 2019; 63: 48-55
    PubMedGoogle Scholar
  • 15 Vorster M, Mokaleng B, Sathekge MM. et al. A modified technique for efficient radiolabeling of 68Ga-citrate from a SnO2-based 68Ge/68Ga generator for better infection imaging. Hell J Nucl Med 2013; 16: 193-198
    PubMedGoogle Scholar
  • 16 Rizzello A, Di Pierro D, Lodi F. et al. Synthesis and quality control of 68Ga citrate for routine clinical PET. Nucl Med Commun 2009; 30: 542-545
    CrossrefPubMedGoogle Scholar
  • 17 Ankrah AO, Glaudemans AWJM, Maes A. et al. Tuberculosis. Semin Nucl Med 2018; 48: 108-130
    CrossrefPubMedGoogle Scholar
  • 18 Dondi M, Kashyap R, Paez D. et al. Trends in nuclear medicine in developing countries. J Nucl Med 2011; 52: 16S-23S
    CrossrefPubMedGoogle Scholar
  • 19 El Sahly HM, Teeter LD, Pan X. et al. Mortality Associated with Central Nervous System Tuberculosis. The Journal of infection 2007; 55: 502-509
    CrossrefPubMedGoogle Scholar
  • 20 Torres C, Riascos R, Figueroa R. et al. Central nervous system tuberculosis. Top Magn Reson Imaging 2014; 23: 173-189
    CrossrefPubMedGoogle Scholar
  • 21 Malherbe ST, Shenai S, Ronacher K. et al. Persisting positron emission tomography lesion activity and Mycobacterium tuberculosis mRNA after tuberculosis cure. Nat Med 2016; 22: 1094-1100
    CrossrefPubMedGoogle Scholar
  • 22 Vorster M, Maes A, Jacobs A. et al. Evaluating the possible role of 68Ga-citrate PET/CT in the characterization of indeterminate lung lesions. Ann Nucl Med 2014; 28: 523-530
    PubMedGoogle Scholar
  • 23 Lucignani G, Orunesu E, Cesari M. et al. FDG-PET imaging in HIV-infected subjects: relation with therapy and immunovirological variables. Eur J Nucl Med Mol Imaging 2009; 36: 640-647
    CrossrefPubMedGoogle Scholar
  • 24 Salomäki SP, Kemppainen J, Hohenthal U at al. Head-to-Head Comparison of 68Ga-Citrate and 18F-FDG PET/CT for Detection of Infectious Foci in Patients with Staphylococcus aureus Bacteraemia. Contrast Media Mol Imaging 2017; 2017: 3179607
    PubMedGoogle Scholar
  • 25 Aro E, Seppänen M, Mäkelä KT. et al. PET/CT to detect adverse reactions to metal debris in patients with metal-on-metal hip arthroplasty: an exploratory prospective study. Clin Physiol Funct Imaging 2018; 38: 847-855
    CrossrefPubMedGoogle Scholar
  • 26 Tseng JR, Chang YH, Yang LY. et al. Potential usefulness of 68Ga-citrate PET/CT in detecting infected lower limb prostheses. EJNMMI Res 2019; 9: 2
    CrossrefPubMedGoogle Scholar